Provider Demographics
NPI:1184723777
Name:SHANDS TEACHING HOSPITAL AND CLINICS, INC.
Entity type:Organization
Organization Name:SHANDS TEACHING HOSPITAL AND CLINICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-733-1500
Mailing Address - Street 1:PO BOX 100303
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0303
Mailing Address - Country:US
Mailing Address - Phone:352-627-9045
Mailing Address - Fax:
Practice Address - Street 1:3951 NW 48TH TER
Practice Address - Street 2:STE 101
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7229
Practice Address - Country:US
Practice Address - Phone:352-265-5230
Practice Address - Fax:352-265-5231
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHANDS TEACHING HOSPITAL AND CLINICS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-21
Last Update Date:2025-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4286261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCH9176OtherMEDICARE RAIL ROAD
FL378448700Medicaid
FL3-3991Medicare PIN